|Implemented in this survey?|
The government is planning to enact a completely new Health Care Act which would regulate the organisation of municipal health care services in the future. A working group set by the Ministry of Social Affairs and Health has made a proposal for the new act. It would reform the system by several means: by increasing co-operation between primary and secondary care, by increasing patient choice and by somewhat centralizing the steering of health services. The bill is going to be passed in 2009.
The government is planning to merge the Primary Health Care Act (enacted in 1972) and the Act on Specialized Medical Care (enacted in 1989) into a comprehensive Health Care Act. These acts regulate the provision of public sector (municipal) health services. Currently municipal primary care is organized by about 260 health centres owned by a municipality or a group of municipalities, specialized care is organized by 20 hospital districts (formed by municipalities) and the organization of tertiary care is co-ordinated by five tertiary care regions (formed by hospital districts).
A working group set up by the Ministry of Social Affairs and Health has made a proposal for the new act. Central reforms in the proposed act are the following:
The central aims of the reform are to strengthen primary health care, to improve access to services and efficiency of service production, to increase co-operation between primary and specialized care, to improve customer orientation and to decrease differences in health status between population groups and geographical areas.
The barrier between primary and specialized care is regarded as one of the main problems of Finnish health care system, which partly stems from having separate acts regulating them. While these acts are merged several other aspects of the health care system needing improvement are to be addressed as well (such as consumer orientation).
Municipalities, Hospital districts, Patients
|Medienpräsenz||sehr gering||sehr hoch|
Improving the coordination of primary and specialized care is not a brand new idea. There have been for example several regional reforms to pilot this. Some other issues in the proposal are more innovative, however. Perhaps the most fundamental change is the increase of patient choice. So far public discussion on the reform has been modest and there have not emerged any strong controversies about it.
There has been discussion on merging the acts for a long time but the major step forward was taken when the current government came into office in April 2007. The program of that government (a plan of action defining the main tasks facing the incoming administration) stated among other things that the Primary Health Care Act and the Act on Specialized Medical Care will be combined into a comprehensive Health Care Act to lower the barriers between primary and specialized care and to improve co-operation (see HPM 10/2007).
|Implemented in this survey?|
The idea to merge these two acts is not novel, but because of a lack of political will, process for the legislation reform had not been started earlier. Having separate acts and organizational structures for primary and specialized care has hindered co-operation between these levels which can hamper the optimal organization of care from both the clinical and economical perspective. For example, sharing patient records and other information between primary and specialized care can be difficult. The separate organizations can also lead to a situation where primary health care has a too weak position in resource allocation. When facing a difficult financial situation, municipalities have better possibilities to limit the costs of their own health center than those of the hospital district.
These acts would need technical reform in any case. Especially the Primary Health Care Act is old (from 1972) and has been amended many times which has made the law rather difficult to interpret.
There have been a few local reforms which have piloted the merging of organizational responsibility of primary health care and specialized care (see HPM 9/2007 and HPM 2/2003), which have been considered to be rather successful.
The approach of the idea is described as:
Local level - see HPM 9/2007 and HPM 2/2003
The working group which drafted the act included representatives from the Ministry of Social Affairs and Health, from the Ministry of Finance, from the Association of Finnish Local and Regional Authorities, from two hospital districts, from one municipality and from three municipal federations providing primary health services.
The themes of the reform are not very controversial, partly because the proposed act is rather general giving just broad outlines for organization of services (like the current acts on primary care and specialized care). The proposal introduces two alternative schemes for organizing primary and specialist care, instead of a single scheme for the whole country. One of the main concerns voiced against the merging of acts has previously been that it can lead to a situation where primary health care would have an even weaker position than it currently has.
However, there will probably be much discussion between the different stakeholders on the details. The ministry has asked all stakeholders to provide written statements on the proposal by the end of October 2008. Public discussion on the proposal of the working group has not really started yet.
Increasing patient choice, which is one of the main novel issues proposed, has not been so much voiced by patients or the public but for example the Finnish Medical Association and private providers have been active in promoting this issue for some time.
|Government||sehr unterstützend||stark dagegen|
|Ministry of Social Affairs and Health||sehr unterstützend||stark dagegen|
|Municipalities||sehr unterstützend||stark dagegen|
|Hospital districts||sehr unterstützend||stark dagegen|
|Public||sehr unterstützend||stark dagegen|
|Patient organizations||sehr unterstützend||stark dagegen|
|Physicians||sehr unterstützend||stark dagegen|
|Nurses||sehr unterstützend||stark dagegen|
After the current government took office, the Ministry of Social Affairs and Health set up a working group in June 2007 to draft a proposal for the new act. The proposal was finalized and publicized by the working group in June 2008. After a thorough process to hear the opinions from relevant stakeholders, the government is planning to pass the bill to parliament in 2009.
|Ministry of Social Affairs and Health||sehr groß||kein|
|Hospital districts||sehr groß||kein|
|Patient organizations||sehr groß||kein|
The main actors to be involved in the adoption process are municipalities and hospital districts. The adoption process will be moderated by the Ministry of Social Affairs and Health.
Not decided yet.
It is possible that this act will be one of the major mile stones in the development of the Finnish health care system since the 70's when the Primary Health Care Act was enacted. However, the proposal made by the working group does not necessarily implicate that there would be in practice many fundamental changes in the system. Perhaps the most promising feature of the proposed act is that it gives a rather good platform for future developments of the municipal health care system as a whole.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
At this stage it is difficult to estimate what is going to be the real impact of the reform on equity, quality and cost-efficiency of health services in Finland.